Lvn Utilization Management Compliance Jobs

Job Title: Utilization Review Licensed Vocational Nurse (LVN) – Utilization Management

Required: Licensed Vocational Nurse, CEU requirement.

Preferred: Computer and Coding experience.

Required: Good organization and communication skills

Required: HMO, PPO and POS insurance knowledge

Employee Reward and Recognition Program

Experience working in a health plan medical management documentation system a plus

Identifies and refers members to the appropriate healthcare program (e.g. case management, disease management).

All other job-related duties as it relates to the job function or as delegated by management.

2 years managed care experience in UM/CM Department, preferred

Include minimum education, technical training, and/or experience preferred to perform the job.

Proper identification of eligibility and health plan benefits

Minimum 2 years of utilization / care management experience applying evidence-based criteria.

Experience performing medical management (UM) in electronic referral application preferred.

Utilization Review (LVN/RN), Medical Management - FT/Days

Assures review turnaround times adhere to timeliness standards set by contracting and regulatory requirements and established productivity and quality guidelines.

Implement and maintain systems and processes that meet various regulatory requirements.

Maintain and demonstrate a complete understanding of own scope of practice of licensure and education level.

Participates in educational programs to enhance care management (UM and CM) compliance knowledge

2+ years of care management, utilization review (prior authorization) or discharge planning experience

LVN Utilization Management Compliance (Remote)

Leverages knowledge of clinical services regulatory and delegation requirements to represent Optum Clinical Services appropriately while managing delegation oversight audits

Serves as a liaison between Health Plan delegated entities and Clinical Services Operational teams (Utilization Management and Case Management)

Experience in an HMO or experience in a Managed Care setting